Location and distribution of myofascial trigger points on patients with chronic tension-type headache and migraine

Abstract

According to myofascial trigger points on the areas of head, upper back, neck and shoulder were found to associate with chronic tension-type headache (CTTH) and migraine. To determine the location of trigger points may guide to develop an effective treatment.  This study aimed to verify the common locations and distribution of trigger points in these body regions of the patients. Fourth-five participants (24 with CTTH and 21 with migraine) were recruited. To identify the trigger points based according to location, these body parts were divided into 4 regions which include head, upper back, neck, and shoulder. The Simons’diagram of referred-pain zone was used to identify each specific muscle having trigger points on manual palpation on the relevant muscles.  Pressure pain threshold was measured on the most painful trigger point using a digital algometer. The results revealed that the most common trigger points were found at the upper part of neck and occiput (38.9 % on left and 29.3 % right side). The average number of trigger points per person per region was 4.6 ± 1.4 points, equally located on left and right sides (1.8 ± 0.8 and 1.4 ± 1.0 points per person). Thirty two participants (71.1 %) were found to have the most painful and referred trigger points which most of them were located in upper trapezius muscle (50 %). These trigger points were found similar in terms of numbers in left and right sides (56.25 and 43.75 %, respectively). In addition, the average of pressure pain threshold of this most painful trigger point was 1.09 ± 0.45 kg/cm². In conclusion, we found that the most common sites of trigger points were located at the upper part of neck and occiput.  Upper trapezius was the muscle that found the most painful and referred trigger points.    These results may provide primary information for understanding the trigger point’s distribution which may account for a clinical reference for developing therapeutic effectiveness of chronic headache.